By Dr. Yoon Jeon. MChiro, MB, BSc, Dip.TCM, PGCert.
Case Presentation
A 33-year-old office worker, a married father of one child, presented to the clinic with complaints of neck pain and shoulder pain.
The neck pain had started approximately one year prior, associated with increased stress and recurrent headaches. The shoulder pain had developed more recently over the past few months.
The patient had previously been prescribed strong painkillers and muscle relaxants; however, these provided limited relief and did not resolve his symptoms.
The neck pain was aggravated by left lateral flexion and rotation, with no clearly identifiable relieving factors. The shoulder pain was described as a persistent dull ache.
The patient also reported recurrent headaches accompanied by neck stiffness.
Clinical Examination
On examination:
-
Active trigger points were identified in the upper trapezius muscles bilaterally (left greater than right), with referral patterns reproducing headache symptoms
-
Segmental restriction was noted at:
-
C0–C1 (upper cervical spine)
-
Cervicothoracic (CT) junction
Movement assessment revealed:
-
Neck flexion, extension, and left rotation/lateral flexion reproduced pain in the left upper trapezius
Orthopaedic and neurological testing:
-
Cervical and shoulder orthopaedic tests were unremarkable
-
Neurological examination (sensory, motor, reflexes) of both upper and lower limbs was within normal limits
Clinical Impression
The presentation was consistent with:
-
Cervical spine dysfunction (upper cervical and CT junction)
-
Myofascial pain syndrome with active trigger points (upper trapezius)
-
Cervicogenic headache and/or trigger point–related referred headache
Headaches are commonly associated with cervical joint dysfunction, but may also arise from referred pain patterns originating from muscular trigger points.
Treatment
A combined treatment approach was implemented, including:
Chiropractic Cervical Spinal Manipulation / Adjustment
High-velocity, low-amplitude (HVLA) adjustments were applied to the C1–C2 facet joints to restore joint mobility and reduce mechanical dysfunction.
Myofascial Therapy
-
Trigger point therapy targeting upper trapezius and suboccipital muscles
-
Stretching techniques to reduce muscle tension
-
Myofascial release to improve soft tissue function
Dry Needling (Medical Acupuncture)
Dry needling was applied directly to hypertonic and tender points to reduce muscle spasm and pain. Needle insertion into trigger points has been shown to facilitate muscle relaxation, supported by electromyographic studies (Cummings & White, 2001).
Postural & Ergonomic Advice
Guidance was provided to address work-related posture and reduce ongoing mechanical stress contributing to symptoms.
Clinical Rationale
Spinal manipulation has been shown to be effective in the management of neck pain and associated conditions, and may be superior to certain medical interventions such as muscle relaxants in some cases (Hurwitz et al., 1996).
Addressing both joint dysfunction and muscular trigger points is essential in cases where symptoms arise from a combination of biomechanical and myofascial factors.
Outcome
After three weeks of care:
-
Neck pain resolved completely
-
Shoulder pain significantly improved and resolved
-
Headaches subsided
At 3-month follow-up:
-
The patient remained asymptomatic
-
Full functional recovery was achieved
Summary
This case highlights the effectiveness of a combined approach using chiropractic care, acupuncture, and soft tissue therapy in the management of neck pain, shoulder pain, and associated headaches.
Targeting both cervical joint dysfunction and muscular trigger points can lead to rapid and sustained symptom resolution.
References
Hurwitz EL, Aker PD, Adam AH, Meeker WC, Shekelle PG.Spine,1996. Manipulation and mobilization of the cervical spine: a systematic review of the literature. 21:1746-60.
Cummings, T.M., White, A.R. 2001. Needling therapies in the management of myofascial trigger point pain. Archives of Physical Medicine and Rehabilitation 82:986-992
